Low Back Diagnosis Research Articles

Prevalence and characteristics of musculoskeletal complaints in primary care: an analysis from the population level and analysis reporting (POLAR) database

BackgroundElectronic health record datasets have been used to determine the prevalence of musculoskeletal complaints in general practice but not to examine the associated characteristics and healthcare utilisation at the primary care level.AimTo describe the prevalence and characteristics of patients presenting to general practitioners with musculoskeletal complaints.Design and settingA five-year analysis within three Primary Health Networks (PHNs) in Victoria, Australia.MethodWe included patients with at least one face-to-face consultation 2014 to 2018 inclusive and a low back (≥ 18 years), and/or neck, shoulder or knee (≥ 45 years) complaint determined by SNOMED codes derived from diagnostic text within the medical record. We determined prevalence, socio-demographic characteristics and diagnostic codes for patients with an eligible diagnosis; and number of consultations within one year of diagnosis.Results324,793/1,294,021 (25%) presented with at least one musculoskeletal diagnosis, of whom 41% (n = 133,279) fulfilled our inclusion criteria. There were slightly more females (n = 73,428, 55%), two-thirds (n = 88,043) were of working age (18–64 years) and 83,816 (63%) had at least one comorbidity. Over half had a low back diagnosis (n = 76,504, 57%) followed by knee (n = 33,438, 25%), shoulder (n = 26,335, 20%) and neck (n = 14,492, 11%). Most codes included ‘pain’ and/or ‘ache’ (low back: 58%, neck: 41%, shoulder: 32%, knee 26%). Median (IQR) all-cause consultations per patient within one year of diagnosis was 7 (4–12).ConclusionThe burden of MSK complaints at the primary care level is high as evidenced by the prevalence of people with musculoskeletal complaints presenting to a general practitioner, the preponderance of comorbidities and the numerous consultations per year. Identification and evaluation of strategies to reduce this burden are needed.

P52. Health care use after incident visits for low back conditions in the Veterans Health Administration

<h3>BACKGROUND CONTEXT</h3> Patients commonly seek care for low back conditions, however details on care associated with the initiation of new visits are little understood. <h3>PURPOSE</h3> To describe clinical, demographic, and service use characteristics of patients with incident visits for low back conditions in the Veterans Health Administration (VA). <h3>STUDY DESIGN/SETTING</h3> A serial cross-sectional analysis of VA administrative data. <h3>PATIENT SAMPLE</h3> Between October 1, 2016 and September 30, 2017, patients with a visit that included a low back condition, as identified by ICD-10 codes, without such a visit in the prior year, were included in the cohort. <h3>OUTCOME MEASURES</h3> Frequencies of clinics in which the initial visit occurred, and clinics in which subsequent visits including low back diagnoses occurred within the next 365 days. <h3>METHODS</h3> Data were extracted from VA's Corporate Data Warehouse and analyzed in SAS. <h3>RESULTS</h3> We found 55,628 patients (mean age 48.2 years; 11.8% female; 61.3% white) meeting the inclusion criteria. The Charlson Comorbidity Index was >0 in 29.4% of the cohort, post-traumatic stress disorder was present in 17.5%, major depressive disorder in 16.5%, and alcohol use disorder in 5.9%. Four percent had filled prescriptions for opioids, 3.2% benzodiazepines and 0.33% both. The most common locations for initial visits were primary care clinics (80.5%), emergency department (6.9%), and physical therapy (2.2%). Within the year following the index visit, 35,944 patients received 139,031 other visits which included a low back diagnoses code. Those who received any other visits were more likely to be female (Odds Ratio [OR] 1.55, 95% Confidence Interval [CI] 1.47-1.64), or have co-morbid neck diagnoses (OR 1.29, 95% CI 1.22-1.38). The most common locations for subsequent visits were physical therapy (26.4%) primary care (25.3%), chiropractic care (8.8%), and pain medicine (5.3%). <h3>CONCLUSIONS</h3> New visits for low back conditions in VA most commonly occurred in primary care clinics. Most patients presenting for an initial visit were seen in a variety of clinics within the next year. On the index visit date there was a high prevalence of medical and mental health comorbidity, and prescription medication use, which may influence both the subsequent sites and rate of care. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Perfil de trabalhadores com lombalgia atendidos em um serviço de saúde

INTRODUÇÃO: As transformações no mundo do trabalho têm propiciado o acúmulo de tarefas, exigências de polivalência e aumento do ritmo de trabalho, ocasionando um aumento de lombalgias. OBJETIVO: Descrever o perfil de trabalhadores com lombalgia, atendidos em uma unidade especializada em Saúde do Trabalhador da Baixada Santista. MÉTODOS: Trata-se de um estudo observacional transversal e exploratório. Ocorreu análise documental de prontuários abertos de trabalhadores atendidos no Centro de Referência em Saúde do Trabalhador (CEREST) de Santos-SP, no período de julho de 2014 a julho de 2015, com queixa de lombalgia e diagnósticos nosológicos estabelecidos para “outras dorsopatias” (M51 a M54) segundo a CID-10. Foram obtidos os dados: demográficos, variáveis clínicas, categorias profissionais, entre outras. RESULTADOS: De 502 prontuários, 21,9% (n=110) apresentaram queixa de lombalgia e diagnóstico clínico pela CID-10. Houve predomínio do sexo feminino (58,2%), na faixa etária de 35 a 45 anos (50,9%) e baixa escolaridade, com ensino fundamental incompleto (35,4%). Ainda, 23,7% dos sujeitos estavam em situação de afastamento do trabalho e 85,0% com registro em carteira de trabalho (CLT). As categorias profissionais mais prevalentes foram de serviços domésticos, 28,3% (n=31) e atividades de limpeza, 19,1% (n=21). Dos sujeitos, 68,2% tiveram assistência de Fisioterapeutas. CONCLUSÃO: A prevalência foi maior no sexo feminino, de trabalhadores formais e afastados do trabalho, do setor de serviços domésticos e atividades de limpeza, de baixa escolaridade, e com a faixa etária considerada produtiva para o trabalho.

Persistent smoking as a predictor of disability pension due to musculoskeletal diagnoses: A 23 year prospective study of Finnish twins

ObjectiveTo investigate whether stability or changes in smoking predict disability pension (DP) due to low back diagnoses (LBD) and musculoskeletal diagnoses (MSD) after taking familial confounding into account using a co-twin design. MethodLongitudinal smoking patterns and multiple covariates in a population-based cohort of 17,451 Finnish twins (6959 complete pairs) born before 1958 were surveyed through questionnaires in 1975 and 1981. The outcome data were collected from the national pension registers until the end of 2004. Cox proportional hazards regression models were used for statistical analyses. ResultsDisability pension due to low back diagnoses was granted to 408 individuals and disability pension due to musculoskeletal diagnoses to 1177 individuals during the follow-up of 23years. Being a persistent smoker (current smoker both 1975 and 1981) predicted a significantly increased risk for disability pension (hazard ratio 1.69, 95% confidence interval 1.46, 1.97) compared to those individuals who had never smoked. The association remained when several confounding factors, including familial factors, were taken into account. ConclusionPersistent smoking predicts early disability pension due to musculoskeletal diagnoses and low back diagnoses independently from numerous confounding factors, including familial effects shared by the co-twins.

Sleep Patterns as Predictors for Disability Pension Due to Low Back Diagnoses: A 23-Year Longitudinal Study of Finnish Twins

Impaired sleep patterns are known to be associated with many chronic conditions and ultimately they may lead to permanent work incapacity. Less is known about the associations between sleep patterns and cause-specific disability pensions, such as low back diagnoses, or whether familial factors (genetics and family environment) can affect the associations. The objective of this study was to investigate sleep patterns as predictors of disability pension due to low back diagnoses with a 23-year follow-up. A prospective cohort study with comprehensive mailed questionnaires about sleep patterns, e.g., quality and length of sleep in 1975 and 1981. Follow-up from the national disability pension register data until 2004. Not applicable. There were 18,979 individuals (7,722 complete twin pairs) born before 1958. Cox proportional hazards regression was used to calculate hazard ratios (HR) with 95% confidence intervals (95% CI). Disability pension due to low back diagnoses had been granted to 467 individuals during the follow-up. Sleeping moderately well (HR 1.25; 95% CI 1.02, 1.53), or fairly poorly/poorly (HR 2.05; 95% CI 1.53, 2.73) at baseline predicted a significantly higher risk for disability pension. Stable patterns of sleeping either fairly well (HR 1.29; 95% CI 1.01, 1.64), or stably fairly poorly/poorly (HR 2.29; 95% CI 1.49, 3.52) between 1975 and 1981 were associated with a higher risk as compared to a stable pattern of sleeping well. Furthermore, a decrease in quality of sleep from 1975 to 1981 was associated (HR 1.34; 95% CI 1.03, 1.76) with an increased risk of disability pension. Sleep quality and changes in sleep quality appear to be early predictors for disability pension due to low back diagnoses independently from other confounding factors.

A prospective twin cohort study of disability pensions due to musculoskeletal diagnoses in relation to stability and change in pain

Pain is known to play an important role in the pathway to becoming work disabled, in particular for award of disability pensions (DP) due to musculoskeletal diagnoses (MSD). This prospective cohort study investigated MSD-related pain stability and/or changes as predictors for DP during a 23-year follow-up. Additionally confounding factors were examined to elucidate whether familial effects (including genetics and family background) or socioeconomic status, other pain, or use of medication would affect the associations between pain and DP. Data were available on 11,224 twins (4399 complete pairs) born before 1958 surveyed through questionnaires about background factors and musculoskeletal (low back, neck, and shoulder) pain impairing work ability in 1975 and 1981. The follow-up data were collected from pension registers until 2004. Cox proportional hazards regression models were used. During the 23-year follow-up, 508 DPs due to MSD, 166 DPs due to osteoarthritis (OA), and 162 DPs due to low back diagnoses (LBD) were granted. Musculoskeletal pain impairing work ability both measured at 1 time point and 6 years apart, and either 1 pain location or multiple locations, predicted increased risk for DP due to MSD, OA, and LBD. The associations were independent of familial confounding factors and of several influential background factors, including headache; migraine; use of analgesics, hypnotics, or tranquillizers; life satisfaction; and education and marital status. This study concluded that musculoskeletal pain impairing work ability is an early and direct predictor for DP due to MSD, OA, and LBD.

Effects of Work and Lifestyle on Risk for Future Disability Pension Due to Low Back Diagnoses

To investigate work and lifestyle factors as predictors for disability pension (DP) due to low back diagnoses (LBDs) during a 30-year follow-up. Baseline survey data were obtained in 1975 for 16,028 working-age twins followed with register data on DP, emigration, old-age pension, and death until end of 2004; analyzed by Cox proportional hazards regression. Among those at work at baseline, 470 DPs due to LBDs were granted during the follow-up. Monotonous work, lifting and carrying at work or physically heavy work, and unemployment at least once before baseline were significant predictors for DP. A healthy lifestyle was a protective factor for DP. Family background played a role in all these associations. The factors shared by family members seemed to influence both work and lifestyle factors, which then influenced the incidence of DP due to LBDs.

Personality traits and life dissatisfaction as risk factors for disability pension due to low back diagnoses: A 30-year longitudinal cohort study of Finnish twins

ObjectiveLittle is known about the association of mild symptoms and mental well-being with risk of disability pension (DP) due to somatic diagnoses, even less for DP due to low back diagnoses (LBD). Moderate genetic influences on personality traits, life dissatisfaction and DP exist suggesting that shared genetic influences may underlie these associations. One can control for familial confounding (genetics and family environment) by examining twins. This twin study aimed to investigate personality traits and life dissatisfaction as predictors for DP due to LBD accounting for familial confounding. MethodsData on 24043 twins aged 18–65year in a baseline survey in 1975 was followed up from national DP register data until 2004. Personality traits were assessed using the short version of the Eysenck Personality Inventory and life dissatisfaction was measured with a four item scale on levels of interest, happiness, easiness, and loneliness of life. Cox proportional hazards regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI). ResultsDP due to LBD was granted to 537 individuals during the follow-up. Each one unit increase in life dissatisfaction (HR 1.06; 95%CI 1.03, 1.10) and neuroticism (1.07; 1.03, 1.10) but not extroversion was significantly associated with an elevated risk for DP due to LBD. These associations with life dissatisfaction and neuroticism remained when socioeconomic status, education, and marital status were taken into account, and demonstrated an independence from familial confounding. ConclusionLife dissatisfaction and neuroticism seems to be early, perhaps causal risk factors for DP due to LBD.

Clients' perceptions of contact with professionals within healthcare and social insurance offices.

An increasing number of people interact with professionals within healthcare and social insurance offices during periods of sick leave due to musculoskeletal disorders. Knowledge of clients' perceptions of such contact is scarce. This study analysed clients' perceptions of their contact with professionals within healthcare and social insurance offices. A cohort study was conducted in the municipality of Linköping, Sweden. Participants were all citizens who in 1985 were aged 25-34 years and had at least one new sick-leave spell due to back, neck, or shoulder diagnoses exceeding 28 days (n = 213). In 1996, 11 years after inclusion, a questionnaire about perception of contact with professionals, self-perceived health, and mental health was administered. Register data on sickness absence and disability pension from 1985-96 were also obtained. Factor analysis indicated the existence of three dimensions of contact with professionals: supportive treatment, distant treatment, and empowering treatment. Women perceived their contact with both social insurance officers and healthcare professionals as more supportive than did the men. Respondents with disability pensions perceived their contact with social insurance officers as more supportive and empowering than persons without disability pensions. Respondents with mental health problems perceived their contact with both types of professionals as more distant. Respondents with neck/shoulder diagnoses perceived their contact with healthcare professionals as more empowering than respondents with low back diagnoses. There was a relationship between clients' perceptions of contact with professionals and the sex, disability pension, diagnosis, and mental health of clients.

Characteristics of patients with lower extremity symptoms treated with slump stretching: a case series.

Prospective case series. The purpose of this case series was to describe the criteria used to determine if patients were to receive slump stretch treatment within a treatment-based classification system and to describe selected symptom characteristics associated with these patients. Previous reports from the literature suggest that the slump test position may be a useful treatment and evaluation technique. However, little information has been presented regarding how to identify patients who are appropriate to treat with slump stretching and the symptom characteristics associated with these patients. Prior to recruitment, criteria were established to identify patients who would be considered appropriate to treat with slump stretching. Consecutive patients referred with low back diagnosis or low-back-related diagnoses were then evaluated using a treatment-based classification system. Selected symptom characteristics were collected from patients treated with slump stretching. Out of 88 consecutive patients with low back diagnoses or low-back-related diagnoses, 6 met the study's inclusion criteria and were treated with slump stretching. All pain diagrams were classified as "organic" or "possibly organic," and the most common symptom descriptor was "deep ache." At the discharge session of physical therapy, 5 of 6 patients had symptoms that were more proximally located and all patients reported a decrease in symptom intensity. Favorable changes in symptom intensity and location were observed for this case series, but definitive conclusions cannot be drawn from this study design. Additional research needs to be completed to determine if the slump test position is an effective evaluation and treatment technique.

A 12‐year follow‐up of subjects initially sicklisted with neck/shoulder or low back diagnoses

Neck/shoulder and low back pain are common in the Western world and can cause great personal and economic consequences, but so far there are few long term follow-up studies of the consequences of back pain, especially studies that separate the location of back pain. More knowledge is needed about different patterns of risk factors and prognoses for neck/shoulder and low back pain, respectively, and they should not be treated as similar conditions. The aim of the present study was to investigate possible long-term differences in neck/shoulder and low back symptoms, experienced over a 12-year period, with regard to work status, present health, discomfort and influence on daily activities. A retrospective cohort study of individuals sicklisted with neck/shoulder or low back diagnoses 12 years ago was undertaken. Included were all 213 people who, in 1985, lived in the municipality of Linköping, Sweden, were aged 25-34 years and who had taken at least one new period of sickleave lasting > 28 days with a neck/shoulder or low back diagnosis. In 1996, a questionnaire was mailed to the 204 people who were still resident in Sweden (response rate 73%). Those initially absent with neck/shoulder diagnoses rated their present state of discomfort as worse than those sicklisted with low back diagnoses. Only 4% of the neck/shoulder group reported no present discomfort compared with 25% of the low back group. Notably, both groups reported the same duration of low back discomfort during the last year, which may indicate a higher risk for symptoms in more than one location for subjects with neck/shoulder problems. Individuals with sickness absence of more than 28 days with neck/shoulder or low back diagnoses appear to be at high risk of developing long-standing symptoms significantly more so for those initially having neck/shoulder diagnoses.